Centrelink Special Disability Trust Details Form Instructions
This form contains 162 fields organized into 28 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Applicable Documents Checklist | ||
| Additional Statutory Declaration(s) Section 1209Q(1) | Checkbox |
Check this box if you are providing a copy of an Additional Statutory Declaration(s) Section 1209Q(1).
|
| Grant of Probate | Checkbox |
Check this box if you are providing a copy of the Grant of Probate. Fill only if 'Settlor' is not applicable
Depends on:
Settlor Name
|
| Inventory of the Estate | Checkbox |
Check this box if you are providing a copy of the Inventory of the Estate. Fill only if 'Settlor' is not applicable
Depends on:
Settlor Name
|
| Latest income tax return for the trust | Checkbox |
Check this box if you are providing a copy of the latest income tax return for the trust. Fill only if 'Business name' is filled
Depends on:
Business Name
|
| Profit and loss statement | Checkbox |
Check this box if you are providing a copy of the profit and loss statement. Fill only if 'Business name' is filled
Depends on:
Business Name
|
| Depreciation schedule | Checkbox |
Check this box if you are providing a copy of the depreciation schedule. Fill only if 'Business name' is filled
Depends on:
Business Name
|
| Balance sheet | Checkbox |
Check this box if you are providing a copy of the balance sheet. Fill only if 'Business name' is filled
Depends on:
Business Name
|
| Notes to and forming part of the account | Checkbox |
Check this box if you are providing a copy of the notes to and forming part of the account. Fill only if 'Business name' is filled
Depends on:
Business Name
|
| Business name | ||
| Business Name | Text |
Please provide the name of the business, if applicable.
|
| Contact Person's Daytime Phone Number | ||
| Daytime Phone Number | Text |
Please enter the daytime phone number of the contact person.
|
| Contact Person's Fax Number | ||
| Fax Number Area Code | Text |
Please enter the area code for the contact person's fax number.
|
| Fax Number Main Number | Text |
Please enter the main part of the contact person's fax number.
|
| Contact Person's Name | ||
| Contact Person's Name | Text |
Please provide the full name of the person who can be contacted about the details given on this form.
|
| Contact Person's Position | ||
| Position in relation to trust | Text |
Please provide the contact person's position in relation to the trust.
|
| Contact Person's Postal Address | ||
| Street Address | Text |
Please provide the street number, street name, and other relevant address details for the contact person.
|
| Suburb/City and State | Text |
Please provide the suburb or city and the state for the contact person's postal address.
|
| Postcode | Text |
Please provide the postal code for the contact person's address.
|
| Contributions Beyond Settled Sum Question | ||
| Next Question Number | Text |
Enter the number of the next question to proceed if no contributions beyond the settled sum have been made.
|
| No | Checkbox |
Check this box if there have been no contributions to the trust beyond the settled sum.
|
| Yes | Checkbox |
Check this box if there have been contributions to the trust beyond the settled sum and details will be provided below.
|
| Declaration | ||
| Full Name | Text |
Enter the full name of the person completing this form.
|
| Relationship to Trust | Text |
Provide your relationship to the trust, for example, Trustee or solicitor.
|
| Signature | Text |
Provide your signature to declare that the information given is complete and correct.
|
| Date of Signature | Date |
Enter the date the form is signed.
|
| First Appointor Details | ||
| Appointor Name | Text |
Please enter the full name of the first appointor.
|
| Appointor Address Line 1 | Text |
Please enter the first line of the appointor's address.
|
| Appointor Address Line 2 | Text |
Please enter the second line of the appointor's address, such as suburb or city.
|
| Appointor Postcode | Text |
Please enter the postcode for the appointor's address.
|
| Centrelink Reference Number Part 1 | Text |
Please enter the first part of the Centrelink Reference Number, if known.
|
| Centrelink Reference Number Part 2 | Text |
Please enter the second part of the Centrelink Reference Number, if known.
|
| Centrelink Reference Number Part 3 | Text |
Please enter the third part of the Centrelink Reference Number, if known.
|
| Centrelink Reference Number Part 4 | Text |
Please enter the fourth part of the Centrelink Reference Number, if known.
|
| Appointor Date of Birth | Date |
Please enter the date of birth for the appointor.
|
| Relationship to Beneficiary | Text |
Please enter the appointor's relationship to the beneficiary.
|
| First Contributor Details | ||
| Q9.Name.0 | Text |
Depends on:
Yes
|
| Q9.CRN.01.0 | Text |
Depends on:
Yes
|
| Q9.CRN.02.0 | Text |
Depends on:
Yes
|
| Q9.CRN.03.0 | Text |
Depends on:
Yes
|
| Q9.CRN.04.0 | Text |
Depends on:
Yes
|
| Enter the date in DD/MM/YYYY format | Text |
Depends on:
Yes
|
| Q9.Relationship.0 | Text |
Depends on:
Yes
|
| Enter the date in DD/MM/YYYY format | Text |
Depends on:
Yes
|
| Q9.AmountContributed.0 | Text |
Depends on:
Yes
|
| Q9.DescriptionAsset.0 | Text |
Depends on:
Yes
|
| First Trustee Details | ||
| Name of Trustee | Text |
Enter the full name of the first trustee.
|
| Trustee Address Line 1 | Text |
Enter the first line of the trustee's address.
|
| Trustee Address Line 2 | Text |
Enter the second line of the trustee's address.
|
| Trustee Address Line 3 | Text |
Enter the third line of the trustee's address.
|
| Trustee Postcode | Text |
Enter the postcode of the trustee's address.
|
| Centrelink Reference Number Part 1 | Text |
Enter the first part of the trustee's Centrelink reference number.
|
| Centrelink Reference Number Part 2 | Text |
Enter the second part of the trustee's Centrelink reference number.
|
| Centrelink Reference Number Part 3 | Text |
Enter the third part of the trustee's Centrelink reference number.
|
| Centrelink Reference Number Part 4 | Text |
Enter the fourth part of the trustee's Centrelink reference number.
|
| Trustee Date of Birth | Date |
Enter the trustee's date of birth.
|
| Relationship to Beneficiary | Text |
Enter the trustee's relationship to the beneficiary.
|
| Fourth Trustee Details | ||
| Fourth Trustee Name | Text |
Please provide the full name of the fourth trustee.
|
| Fourth Trustee Address Line 1 | Text |
Please provide the first line of the fourth trustee's residential or mailing address.
|
| Fourth Trustee Address Line 2 | Text |
Please provide the second line of the fourth trustee's residential or mailing address.
|
| Fourth Trustee Postcode | Text |
Please provide the postcode for the fourth trustee's address.
|
| Q8.Address.3.3 | Text | |
| Fourth Trustee Centrelink Reference Number Part 1 | Text |
Please provide the first part of the fourth trustee's Centrelink Reference Number, if known.
|
| Fourth Trustee Centrelink Reference Number Part 2 | Text |
Please provide the second part of the fourth trustee's Centrelink Reference Number, if known.
|
| Fourth Trustee Centrelink Reference Number Part 3 | Text |
Please provide the third part of the fourth trustee's Centrelink Reference Number, if known.
|
| Q8.CRN.3.3 | Text | |
| Fourth Trustee Date of Birth | Date |
Please provide the date of birth for the fourth trustee.
|
| Fourth Trustee Relationship to Beneficiary | Text |
Please describe the fourth trustee's relationship to the beneficiary.
|
| General | ||
| Instructions | Button | |
| Instructions | Button | |
| Q4PostalAddress1 | Text | |
| Q4PostalAddress2 | Text | |
| Q8.Address.0.2 | Text | |
| Q8.Address.1.2 | Text | |
| Q8.Address.0.4 | Text | |
| Q8.Address.1.4 | Text | |
| Button | ||
| Clear | Button | |
| Name of the Special Disability Trust | ||
| Name of the Special Disability Trust | Text |
Provide the official name of the Special Disability Trust.
|
| Principal beneficiary's Centrelink Reference Number | ||
| Centrelink Reference Number Part 1 | Text |
Enter the first part of the principal beneficiary's Centrelink Reference Number.
|
| Centrelink Reference Number Part 2 | Text |
Enter the second part of the principal beneficiary's Centrelink Reference Number.
|
| Centrelink Reference Number Part 3 | Text |
Enter the third part of the principal beneficiary's Centrelink Reference Number.
|
| Centrelink Reference Number Part 4 | Text |
Enter the fourth and final part of the principal beneficiary's Centrelink Reference Number.
|
| Principal beneficiary's date of birth | ||
| Principal Beneficiary's Date of Birth | Date |
Provide the date of birth for the principal beneficiary.
|
| Principal beneficiary's name | ||
| Principal Beneficiary's Name | Text |
Provide the full name of the principal beneficiary.
|
| Real Estate Documents Checklist | ||
| Completed Real Estate Details (Mod R) Form | Checkbox |
Check this box if you have provided a completed Real estate details (Mod R) form for each real estate property owned by the trust. Fill only if 'Description of asset contributed' is 'real estate'
Depends on:
Description of asset contributed
|
| Copy of Transfer or Contract of Sale | Checkbox |
Check this box if you have provided a copy of the transfer or contract of sale for each real estate property owned by the trust. Fill only if 'Completed Real Estate Details (Mod R) Form' is filled because the trust owns real estate.
Depends on:
Completed Real Estate Details (Mod R) Form
|
| Copy of Council Rates Notice | Checkbox |
Check this box if you have provided a copy of the council rates notice for each real estate property owned by the trust. Fill only if 'Completed Real Estate Details (Mod R) Form' is filled because the trust owns real estate.
Depends on:
Completed Real Estate Details (Mod R) Form
|
| Copy of Certificate of Title | Checkbox |
Check this box if you have provided a copy of the certificate of title for each real estate property held by the trust. Fill only if 'Completed Real Estate Details (Mod R) Form' is filled because the trust owns real estate.
Depends on:
Completed Real Estate Details (Mod R) Form
|
| Required Documents Checklist | ||
| Trust deed or Will establishing the Special Disability Trust | Checkbox |
Check this box if you are providing a copy of the Trust deed or Will that established the Special Disability Trust.
|
| Schedule A | Checkbox |
Check this box if you are providing a copy of Schedule A.
|
| Schedule B | Checkbox |
Check this box if you are providing a copy of Schedule B.
|
| Statutory Declaration(s) Section 1209Q(1) | Checkbox |
Check this box if you are providing a copy of the Statutory Declaration(s) under Section 1209Q(1).
|
| Details and documentation of the assets held by the Trust | Checkbox |
Check this box if you are providing details and documentation of the assets held by the Trust, such as bank statements or share certificates.
|
| Second Appointor Details | ||
| Second Appointor Name | Text |
Please enter the full name of the second appointor.
|
| Second Appointor Address Line 1 | Text |
Please enter the first line of the second appointor's address.
|
| Second Appointor Address Line 2 | Text |
Please enter the second line of the second appointor's address.
|
| Second Appointor Suburb/City | Text |
Please enter the suburb or city of the second appointor's address.
|
| Second Appointor Postcode | Text |
Please enter the postcode of the second appointor's address.
|
| Second Appointor Centrelink Ref Number Part 1 | Text |
Please enter the first part of the second appointor's Centrelink Reference Number.
|
| Second Appointor Centrelink Ref Number Part 2 | Text |
Please enter the second part of the second appointor's Centrelink Reference Number.
|
| Second Appointor Centrelink Ref Number Part 3 | Text |
Please enter the third part of the second appointor's Centrelink Reference Number.
|
| Second Appointor Centrelink Ref Number Part 4 | Text |
Please enter the fourth part of the second appointor's Centrelink Reference Number.
|
| Second Appointor Date of Birth | Date |
Please enter the second appointor's date of birth.
|
| Second Appointor Relationship to Beneficiary | Text |
Please enter the second appointor's relationship to the beneficiary.
|
| Second Contributor Details | ||
| Second Contributor Full Name | Text |
Please provide the full name of the second contributor. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Centrelink Reference Number Part 1 | Text |
Please provide the first part of the second contributor's Centrelink Reference Number, if known. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Centrelink Reference Number Part 2 | Text |
Please provide the second part of the second contributor's Centrelink Reference Number, if known. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Centrelink Reference Number Part 3 | Text |
Please provide the third part of the second contributor's Centrelink Reference Number, if known. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Centrelink Reference Number Part 4 | Text |
Please provide the fourth part of the second contributor's Centrelink Reference Number, if known. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Date of Birth | Date |
Please provide the date of birth for the second contributor. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Relationship to Beneficiary | Text |
Please provide the relationship of the second contributor to the beneficiary. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Date of Contribution | Date |
Please provide the date when the contribution was made by the second contributor. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Amount Contributed | Number |
Please provide the total amount contributed by the second contributor. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Contributor Asset Description | Text |
Please provide a description of the asset contributed by the second contributor, such as cash, shares, or real estate. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Trustee Details | ||
| Second Trustee Name | Text |
Please enter the full name of the second trustee.
|
| Second Trustee Address Line 1 | Text |
Please enter the first line of the second trustee's address.
|
| Second Trustee Address Line 2 | Text |
Please enter the second line of the second trustee's address.
|
| Second Trustee Address Line 3 (Suburb/City) | Text |
Please enter the third line of the second trustee's address, which is typically the suburb or city.
|
| Second Trustee Postcode | Text |
Please enter the postcode for the second trustee's address.
|
| Second Trustee Centrelink Reference Number Part 1 | Text |
Please enter the first part of the second trustee's Centrelink reference number, if known.
|
| Second Trustee Centrelink Reference Number Part 2 | Text |
Please enter the second part of the second trustee's Centrelink reference number, if known.
|
| Second Trustee Centrelink Reference Number Part 3 | Text |
Please enter the third part of the second trustee's Centrelink reference number, if known.
|
| Second Trustee Centrelink Reference Number Part 4 | Text |
Please enter the fourth and final part of the second trustee's Centrelink reference number, if known.
|
| Second Trustee Date of Birth | Date |
Please enter the date of birth for the second trustee if they are a person.
|
| Second Trustee Relationship to Beneficiary | Text |
Please describe the relationship of the second trustee to the beneficiary.
|
| Settlor Details | ||
| Settlor Name | Text |
Please enter the full name of the settlor.
|
| Settlor Address Line 1 | Text |
Please enter the first line of the settlor's address.
|
| Settlor Address Line 2 | Text |
Please enter the second line of the settlor's address.
|
| Settlor Address Line 3 | Text |
Please enter the third line of the settlor's address.
|
| Settlor Postcode | Text |
Please enter the postcode for the settlor's address.
|
| Settlor Centrelink Reference Number Part 1 | Text |
Please enter the first segment of the settlor's Centrelink Reference Number.
|
| Settlor Centrelink Reference Number Part 2 | Text |
Please enter the second segment of the settlor's Centrelink Reference Number.
|
| Settlor Centrelink Reference Number Part 3 | Text |
Please enter the third segment of the settlor's Centrelink Reference Number.
|
| Settlor Centrelink Reference Number Part 4 | Text |
Please enter the fourth segment of the settlor's Centrelink Reference Number.
|
| Settlor Date of Birth | Date |
Please provide the settlor's date of birth.
|
| Settlor Relationship to Beneficiary | Text |
Please describe the settlor's relationship to the beneficiary.
|
| Tax file number of the trust | ||
| TFN First Segment | Text |
Please provide the first segment of the trust's Tax File Number.
|
| TFN Second Segment | Text |
Please provide the second segment of the trust's Tax File Number.
|
| TFN Third Segment | Text |
Please provide the third segment of the trust's Tax File Number.
|
| Third Contributor Details | ||
| Full name of contributor | Text |
Please enter the full legal name of the third contributor. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Centrelink Reference Number Part 1 | Text |
Please enter the first part of the contributor's Centrelink Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Centrelink Reference Number Part 2 | Text |
Please enter the second part of the contributor's Centrelink Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Centrelink Reference Number Part 3 | Text |
Please enter the third part of the contributor's Centrelink Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Centrelink Reference Number Part 4 | Text |
Please enter the fourth part of the contributor's Centrelink Reference Number. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date of birth | Date |
Please enter the contributor's date of birth. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Relationship to beneficiary | Text |
Please specify the contributor's relationship to the beneficiary. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Date of contribution | Date |
Please enter the date when the contribution was made. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Amount contributed | Number |
Please enter the monetary amount contributed. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Description of asset contributed | Text |
Please provide a detailed description of the asset contributed, such as cash, shares, or real estate. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Third Trustee Details | ||
| Third Trustee Name | Text |
Enter the full name of the third trustee.
|
| Third Trustee Address | Text |
Enter the full street address of the third trustee.
|
| Third Trustee Postcode | Text |
Enter the postcode of the third trustee's address.
|
| Q8.Address.3.2 | Text | |
| Third Trustee Centrelink Reference Number Part 1 | Text |
Enter the first part of the Centrelink reference number for the third trustee.
|
| Third Trustee Centrelink Reference Number Part 2 | Text |
Enter the second part of the Centrelink reference number for the third trustee.
|
| Third Trustee Centrelink Reference Number Part 3 | Text |
Enter the third part of the Centrelink reference number for the third trustee.
|
| Q8.CRN.3.2 | Text | |
| Third Trustee Date of Birth | Date |
Enter the date of birth for the third trustee if they are a person.
|
| Third Trustee Relationship to Beneficiary | Text |
Enter the relationship of the third trustee to the beneficiary.
|
| Trust Centrelink Reference Number | ||
| Trust CRN Segment 1 | Text |
Enter the first segment of the Trust Centrelink Reference Number. If the trust does not have a CRN, enter 'NIL' in this field.
|
| Trust CRN Segment 2 | Text |
Enter the second segment of the Trust Centrelink Reference Number.
|
| Trust CRN Segment 3 | Text |
Enter the third segment of the Trust Centrelink Reference Number.
|
| Trust CRN Segment 4 | Text |
Enter the fourth segment of the Trust Centrelink Reference Number.
|